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Objective To investigate the influencing factors of postoperative gastroparesis syndrome(PSG)after laparoscopic right hemicolon cancer resection.Methods A total of 1070 patients with laparoscopic right hemicolon cancer resection(complete right hemicolon mesoresection)were selected from Wuhan General Hospital of Yangtze River Shipping and Wuhan Union Hospital Cancer Department from December 2012 to June 2022.According to whether the patients got postoperative gastroparesis,were divided into the postoperative gastroparesis syndrome(PSG)group or the normal control group.Univariate and multivariate Logistic regression analysis were used to analyze the risk factors of PGS after right hemicolon resection.Results There were 29 patients in the gastroparesis group and 1041 patients in the normal control group.Univariate analysis showed that age,perioperative blood glucose level,surgical resection range,and surgical approach were related to the occurrence of PGS(P＜0.05).Multivariate Logistic analysis showed that age,high perioperative blood glucose level,caudal approach plus combined approach,and large surgical resection range were independent influencing factors of PGS(P＜0.05).Conclusions Age,high perioperative blood glucose level,caudal approach plus combined approach,and large surgical resection range are influencing factors of PGS.
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Objective:To investigate the risk factors for the recurrence of lower-extremity arteriosclerosis obliterans in patients after interventional surgery.Methods:The clinical data of 98 patients with lower-extremity arteriosclerosis obliterans who received treatment in Lishui Municipal Central Hospital from January 2021 to January 2022 were retrospectively analyzed. They were randomly divided into a recurrent group ( n = 36) and a non-recurrent group ( n = 62). The immediate efficacy of interventional therapy and the follow-up were determined in each group. Clinical data, triglyceride, high-density lipoprotein cholesterol and low-density lipoprotein cholesterol levels, neutrophil/lymphocyte ratio, and fasting blood glucose level were compared between the two groups. The risk factors for the recurrence of lower-extremity arteriosclerosis obliterans after interventional surgery were further analyzed using logistic regression analysis. Results:The success rate of interventional surgery for aortoiliac artery, superficial femoral artery, and inferior genicular artery were 95.35% (41/43), 97.73% (43/44), and 95.83% (46/48), respectively. Twelve-month follow-up results showed that the patency rate of lower-extremity vessels decreased with time ( P < 0.05). There was a significant difference in Trans-Atlantic Inter Society Consensus (TASC) classification between the two groups (11/26/18/7 vs. 4/5/10/17, χ2 = 18.33, P < 0.05). Ankle-brachial index (ABI) in the recurrence group was significantly lower than that in the non-recurrence group [(0.77 ± 0.12) vs. (0.40 ± 0.02), t = 18.31, P < 0.05]. There were no significant differences in triglyceride, high-density lipoprotein cholesterol, low-density lipoprotein cholesterol, and fasting blood glucose levels between the two groups (all P < 0.05). The neutrophil/lymphocyte ratio (NLR) in the non-recurrent group was significantly lower than that in the recurrent group [(1.98 ± 0.28) vs. (13.18 ± 0.50), t = 15.25, P < 0.05]. Logistic regression analysis results showed that ABI ( OR = 1.459, 95% CI: 1.163-1.832), TASC classification ( OR = 1.344, 95% CI: 1.090-1.658), surgical method ( OR = 1.392, 95% CI: 1.140-1.700) and NLR ( OR = 1.474, 95% CI: 1.184-1.836) were the influential factors of recurrence of lower-extremity arteriosclerosis obliterans (all P < 0.05). Conclusion:ABI, TASC classification, surgical methods, and NLR are the influential factors of lower-extremity arteriosclerosis obliterans after interventional surgery. The above indexes should be closely monitored in clinical practice to maintain the effects of interventional surgery.
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Splenic flexure colon cancer occurs at a relatively lower rate than colon cancer of other sites. It is also associated with more advanced disease and higher rate of acute obstruction. The splenic flexure receives blood supply from both superior and inferior mesenteric arteries (SMA and IMA), and therefore has lymphatic drainage to both areas. The blood supply is also highly variable, causing difficulties in determining the main feeding vessels and the main direction of lymph drainage. Few studies with limited cases focused on this specific tumor site with respect to the patterns of lymph node spread, especially the main lymph node status and the value of its dissection. The lack of information limits the development of a consensus on the extent of surgical resection and lymphadenectomy. Adequate mobilization of the colon facilitates a sufficient length of bowel resection and the high ligation of feeding arteries from both SMA and IMA. Further evidence on the chnoice of procedures and the extent of lymph node dissection need multicenter collaboration, with the use of modern techniques, including CT 3D reconstruction of the colon and angiography, as well as intraoperative fluorescent real-time imaging of lymph nodes.
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Humanos , Colon Transverso/cirugía , Neoplasias del Colon/cirugía , Laparoscopía , Escisión del Ganglio Linfático/métodos , Ganglios Linfáticos/patología , Arteria Mesentérica Inferior/cirugíaRESUMEN
Objective:To explore an effective mode of medical preventive integration, so as to further the construction of county scale health-centered medical alliances.Methods:This study took five medical alliances from a county in Hangzhou as an example, and carried out the semi-structured interview method and typical case analysis to summarize the medical preventive integration operation mode in January 2020; the self-developed questionnaire was used to understand the operation effectiveness evaluation on county medical alliances by medical staffs and residents from fowr aspects: medical preventive team, medical preventive resources, medical preventive services and medical preventive information fusion.Results:Each county scale medical alliance promoted the integration of medical preventive by innovating the organizational structure, strengthening organizational guarantees, and integrating teams, resources, services, and information on medical preventive. The questionnaire survey showed that medical staff had highest satisfaction with the medical preventive service integration (3.75 points), and lowest satisfaction with the medical preventive information integration (3.69 points); residents had highest satisfaction with health information functions in medical preventive information fusion (4.20 points), and lowest satisfaction with preventive health care services in medical preventive services fusion (4.15 points).Conclusions:The evaluation measures related to medical preventive integration services need to be improved, and the quality of services needs to be promoted, all the information systems need to be interconnected, and big data on the information platform needs to be mined and utilized.
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For provincial children's hospitals and children's hospitals affiliated to medical colleges and universities with a high level of the diagnosis and treatment,they are the center of referral and need to retain pediatricians and build a high-level team of pediatricians.With the authors' own experience in Cincinnati Children's Hospital Medical Center in the US,this article briefly introduces the current clinical operation mode in American children's hospitals,especially the consultation system mainly composed of attending physicians and the mode of continuing medical education based on both clinical and scientific research.Such experience provides a reference for pediatricians in China.
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In the United States of America, the physician group practice has become one of the most common practice models, and has a relatively perfect and clear system of laws and regulations in its monitoring.In view of the policy side, the federal government has published the Stark Law to regulate the registration, properties, operation, service contents in details for the physician group practice.Taking the market side, it is practiced to protect the physician groups and medical practice behaviors through medical insurance policies.In China, the emergence of physician group has received widespread attention and concern.But since the short development time and unclear development path, the relevant laws and regulations for physician groups are still are not perfect.This paper aims to summarize the development and status quo of the American physician group as well as the regulations related to the groups` operating system, which will provide a good reference to China.The purpose is to provide policy recommendations for the standardized development and perfect regulations of physician groups in China.The following recommendations were put forward: improve the relevant laws and regulations;promote the establishment of the corresponding security policies;speed up and enhance the research and development of medical liability insurance;do continuous tracking and timely summarize practices.
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Objective To study the application value of MSCT in preoperative evaluation of rectal cancer before surgery.Methods Clinical materials of 146 patients with colonoscopy and clinical proved rectal cancer were recruited.MSCT were performed with plain and triphasic dynamic contrast enhancement before surgery.The value of MSCT was evaluated by comparing the results of pre-operative evaluation with the surgical results.Results 130 cases accepted surgical treatment:3 cases of transanal local excision,28 cases of Miles operation,3 cases of Hartmann operation,96 cases of Dixon.Preoperative evaluation of MSCT:33 cases of Miles,4 cases of Hartmann,88 cases of Dixon,5 cases of local excision of the anus.The accuracy on MSCT preoperative evaluation was 84.62%. MSCT preoperative evaluation consistency was consistent with postoperative outcome(k=0.653,χ2=225.352,P=0.000).Conclu-sion It is high accuracy for MSCT in preoperative evaluation of rectal cancer,and it can provide important significance for preopera-tive selection of surgical procedures.
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Objective To investigate the impact of different kinds of laparoscopic surgery including conventional blunt elimination and modified acute elimination on sex hormone, antral follicle count and ovarian volume of patients with endometriosis (EMs). Methods 100 patients with EMs were chosen from January 2013 to April 2016 and randomly divided into control group (50 patients) with conventional blunt elimination and observation group (50 patients) with modified acute elimination; and the thickness of elimination lesion, the removal rate of ovary cortex, the thickness of ovarian cortex, the level of serum sex hormones, the AFC number of affected side and the volume of ovary before and after operation of the two groups were compared. Results There was no significant difference in the thickness of lesion elimination, the removal rate and removed thickness of ovarian cortical between the two groups (P > 0.05). The thickness of lesion elimination and the thickness of ovarian cortex in middle position of observation group were significantly lower than that in control group (P 0.05). There was no significant difference in the levels of AFC number of affected side before and after treatment (P > 0.05). The levels of AFC number of affected side in hilus ovarii of control group after treatment were significantly lower than that before treatment (P < 0.05). The volume of ovary of both groups after treatment were significantly lower than that before treatment (P < 0.05). The volume of ovary of observation group after treatment were significantly higher than that in control group (P < 0.05). Conclusion Compared with conventional blunt elimination, modified acute elimination in the treatment of patients with EMs can efficiently shorten the operation time, reduce the surgical trauma degree, speed up the recovery process after operation, regulate the level of FSH and AMH and be helpful to protect the ovarian reserve function.
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Objective To explore the prevention of recurrent laryngeal nerve injury through the exposure recurrent laryngeal nerve by different ways in thyroid operation.Methods The patients with thyroid surgery were selected as study objects,and they were randomly divided into the inferior horn of thyroid cartilage and the inferior thyroid artery group according to the digital table.The operation time,amount of bleeding and the time of postoperative hospitalization were compared between the two groups,and the incidence of recurrent laryngeal nerve injury was analyzed.Results The differences were not statistically significant in the operation time,amount of bleeding and the time of postoperative hospitalization between the two groups (t=1.294,0.967,1.008,all P>0.05).The incidence rate of recurrent laryngeal nerve injury in the inferior thyroid artery group(4.61%) was higher than that in the thyroid cartilage angle group(1.54%)(χ2=4.203,P0.05).Conclusion The exposure recurrent laryngeal nerve through the inferior horn of thyroid cartilage in thyroid operation can protect the recurrent laryngeal nerve,and can not increase the operation time,bleeding volume and the hospitalization time after surgery,which is worthy of further application.
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With the development of health care, the use of modern medical devices and the improvement of hospital manage-ment system, Intensive care unit( ICU) emerges.ICU is a treatment-nursing ward, which is a collection of modern medical care tech-nology.With ICU information constructive practice of Nanjing General Hospital of Nanjing Military Region as the background, this pa-per introduces the target base、functional requirements、business processes of the intensive care information system management mode of operation from the perspective of clinical application.Furthermore, this paper describes the realization of the function of the mode of operation with cases as evidence.
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Objective To compare the curative effects between one‐stage anterior debridement bone graft fusion and posteri‐or fixation fusion combined with anterior debridement bone graft fusion in the treatment of multiple lower thoracic spinal tuberculo‐sis .Methods A total of 62 patients with multiple lower thoracic spinal tuberculosis in our hospital from March 2002 to March 2010 were treated by the anterior debridement bone graft fusion ,including 32 cases of anterior internal fixation by one screw‐rod system (group A) and 30 cases of posterior internal fixation by two nail‐stick systems(group B) .The cure rate ,operation time ,bleeding volume ,the Cobb′s angle and recovery situation of spinal cord injury were compared between the two groups .Results All patients were followed up for 24-36 months (average 28 months) and showed successful bone graft fusion .In the Frankel classification e‐valuation at postoperative 12 months ,the improvement rate of spinal cord injury was 76 .92% (10/13) in the group A and 81 .82%(9/11) in the group B ,showing no statistically significant difference (χ2 =0 .087 ,P>0 .05) .The total cure rate was 84 .38% (27/32) in the group A and 85 .48% (26/30) in the group B ,showing no statistically significant difference (χ2 =0 .066 ,P>0 .05) .The Cobb′s angles before operation ,immediately after operation and at the last follow‐up were (28 .16 ± 4 .16)° ,(5 .03 ± 3 .24)° and (8 .81 ± 2 .44)° in the group A and (26 .83 ± 5 .41)° ,(5 .50 ± 3 .03)° and(8 .06 ± 2 .45)° in the group B ,showing no statistically sig‐nificant difference (t=1 .038 ,t=0 .588 ,t=1 .200 ,all P>0 .05) .The operation time was (171 .31 ± 12 .84)min in the group A and (219 .23 ± 21 .44)min in the group B ,showing statistically significant difference (t=10 .754 ,P<0 .05) .The bleeding volume was (341 .25 ± 76 .10)mL in the group A and (440 .67 ± 67 .16)mL in the group B ,showing statistically significant difference (t=5 .439 ,P<0 .05) .Conclusion One‐stage anterior debridement ,and anterior or posterior internal fixation for treating multiple lower thoracic spinal tuberculosis can obtain the better curative effect ,but selecting case is very important .
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OBJECTIVE:To provide new ideas for the supervision of TCM decoction for patients. METHODS:The mode of outsourced TCM decoction for patients in Nanjing and Hangzhou area were investigated and analyzed,especially their operation mode. The safety problems of quality of the mode were analyzed from the legitimacy and standardization. RESULTS & CONCLU-SIONS:The present problems include the mismatch of professional and technical personnel of TCM decoction pieces and their qua-lification requirements;the lack of communication of pharmacists and prescribers;no restrictions for outsourced decoction of toxic TCM decoction pieces for patients;the insufficient attention for the quality and safety of packaging materials;being difficult to im-plement the main responsibility of medical institutions,etc. It is suggested to establish the filing system of centralized TCM decoc-tion institution for patients;the stationed system of pharmacy technician in medical institutions;the training and evaluation system of dispensing,decocting and other stations;the regular inspection system of health and pharmaceutical administration department;the quality evaluation system of TCM decoction for patients by following up medical staff and patients. So that it can explore a new idea for monitoring ofclearing the powers of regulatory,full participation in medical institutions,standardization and management of pharmaceutical wholesale enterprises,active supervision by patients.
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Objective To compare three kinds of operation method in the treatment of glaucoma with cata-ract indications and clinical efficacy .Methods 90 patients with glaucoma combined with cataract were randomly divided into A,B,C three groups,patients in group A underwent phacoemulsification and IOL implantation therapy , patients in group B underwent phacoemulsification and IOL implantation combined with peripheral iridectomy treat -ment,patients in group C underwent phacoemulsification and IOL implantation and trabecular bite resection ,compared three groups of patients with clinical curative effect The .Results of three groups of patients before treatment and operation visual acuity compared to no significant difference (P>0.05),the treatment after operation,all patients vis-ual acuity was improved ,no significant difference in visual contrast and three group of patients after operation ( P>0.05).Three groups of patients before operation ,1 week after operation,6 months after the IOP had no statistically significant difference ( P>0.05);the same group of patients before and after operation in different time points .The intraocular pressure had significant differences (P<0.05).Three groups of patients with postoperative iris root is rela-tively flat,wide angle increases,and the remaining peripheral iris mucosal area has been narrowed ,visible range be-come larger;no serious complication occurred .Conclusion Glaucoma patients with cataract treated with three kinds of operation mode ,can significantly improve the visual acuity of patients ,so it has high value in clinical application .
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In order to encourage the development of traditional Chinese medicine (TCM), the state has set up a spe-cial project and funds to construct the National TCM Clinical Research Base. The goal is to establish a regular line with the development of TCM clinical research and innovation platform gradually. Ensuring the project proceeds suc-cessfully, we have taken a series of initiatives that include the personnel training, the establishment of the network center, medical diagnostic centre, imaging centre, ethical platform and the laboratory. Also, we have explored the operation mode which matches the construction. During the process of construction, we have found that four elements are particularly important for the base development, which are top-level design, leadershipˊs attention, financial sup-port, solidarity and cooperation.
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The paper elucidates the theory and connotation of intensive management of hospital,discusses the domestic and foreign research status on hospital management,and studies the management mode of hospital by analyzing the internal and external environment of hospitals in China.By referring to the experience of foreign experts and the different concepts put forward by domestic experts,introducing medical value chain theory,and attaching importance to the contact with patients and the basic core of medical service.Chinese hospitals can integrate the internal operation system of hospital using scientific and technological means to form a new type of dynamic organization structure and implement intensive management of medical input and output of quality benefit.
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Objective To assess the cost-effectiveness of different modes of the cataract operation. Methods Firstly, 291 cases of cataract inpatient were divided four groups according to operation modes (PHACO and ECCE) and the prices of intraocular lens (IOL) (high and low). Then the comparisons of inpatient cost, operation cost, postoperative VA, postoperative VF and QOL were made among four groups respectively. Finally, the cost-effectiveness of different cataract operation modes was analyzed by comparing the differences of their costs with the VA, VF and QOL improvement. Results There were significant differences in the above indicators among four groups in general (P 0.01). The VA improvement amount of PHACO was higher than that of ECCE whereas the VF and QOL improvement lower than those of ECCE. The price of IOL had no effect on the improvement quantity of VA, VF and QOL. When one unit amount of VA improvement wanted, the cost-effectiveness ratio of inpatient with PHACO and low-price IOL was the lowest. When one unit amount of VF and QOL improvement wanted, the cost-effectiveness ratio of patients with ECCE and high-price IOL was the lowest. When one unit amount of VA and QOL improvement wanted, the operation cost-effectiveness ratio of ECCE with low-price IOL was the lowest. And when one unit amount of VF improvement wanted, the operation cost-effectiveness ratio of ECCE with high-price IOL was the lowest. Conclusions There were cost differences among different cataract operation modes. The cost of PHACO was higher than that of ECCE. The ECCE mode and price of IOL were the main determinants of cost. The effects of improving VA and QOL by ECCE were better and the effect of improving VA by PHACO was better than by ECCE. The homemade or low price IOL had no influence on the cataractous operative effectiveness, but could decrease the operation cost. ECCE with low-price IOL was the optimal cost-effectiveness strategy and operation mode, especially for poor rural and remote areas.